MEDICARE: DR. JOYCE TAGARISA DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	21657	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	201127634026	OTHER	OH	CARESOURCE

General Provider Information

NPI Number	:	1639238017
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOYCE TAGARISA DDS

Provider Business Mailing Address
First Line	:	17 N KING ST
Second Line	:
City	:	XENIA
State	:	OH
Zip	:	45385-0030
Country	:	US
Telephone Number	:	937-410-0451
Fax Number	:	937-562-3400

Provider Business Practice Location Address
First Line	:	17 N KING ST
Second Line	:
City	:	XENIA
State	:	OH
Zip	:	45385-0030
Country	:	US
Telephone Number	:	937-410-0451
Fax Number	:	937-562-3400

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/08/2006
Last Update Date	:	06/02/2026

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